Several different types of specimens may be received for the diagnosis and management of aganglionosis (Hirschsprung's  disease):

• Transrectal mucosal biopsy:  measure and describe as in Gastrointestinal Mucosal Biopsy.
• Full thickness bowel specimen:  measure and describe as in Bowel Resection for Non-Neoplastic Condition.
• Distal colon resection (pull-through):
• Identify proximal and distal ends of the specimen.
• Remove all mesenteric attachments to allow the specimen to lie flat when it has been opened.
• Open the specimen longitudinally and pin it to a board prior to fixation for 24 hours in 10% formalin.
• Measure and describe as in Bowel Resection for Non-Neoplastic Condition.

• Transrectal mucosal biopsy:  place entire specimen in a cassette and request serial sections (not levels)
• Full thickness bowel specimen:  entirely submit (unless very large) and request three levels.  Orient the specimen to have sections cut through the entire bowel wall, particularly the muscular layers.
• Distal colon resection (pull-through):  sample the entire length of the resected specimen with longitudinally-oriented blocks.
• Identify the blocks sequentially from distal to proximal.  For very long portions of resected colon, two portions may be placed in a cassette with appropriate labeling.

Received without fixative/in formalin, labeled with the patient’s name, medical record number, and “_____”, are __ (number; if more than 5 use multiple) strips/irregularly shaped fragments of _____ (color) soft/friable/firm _____ tissue measuring __ x __ x __ cm in aggregate. The largest piece is __ x __ x __ cm.  Entirely submitted in a tissue processing bag.

#__ = largest fragment

#__ = remaining fragments

__ blocks, __ H&E, __ Alcian yellow